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AESTHESIA in SOUTH AFRICA * Lllstory OF 244 S.A. MEDICAL JOURNAL 1 March 1958 , whom are available at the ame time. Where po ible tbe Ward accommodation, eparate from the general ward, medical officer should be well experienced and of senior should, if possible, be provided for staff. Accurate record of tatu . all attendances, injection, reports X-ray, etc., hould be uitable consulting and examination room mu t be pro­ maintained. Staff in general and nur es in particular should vided and ick parades hould start at an early hour in the not have access to their clinical records. However as with morning 0 that tho e who are fit to return to duty do not any patient, an explanation of the magno i is e ential. wa te time waiting r r the doctor. Facilitie for ick staff to Living-out taff who ab ent them elves becau e of illness report for iLlnesse that manifest themsel es after ick parade hould produce a medical certificate. mu t al 0 be available. The attitude, 'Get ick before 9 a.m. Personal Background. ]t i mo t important to get to know or wait till tomorrow', is a dangerou one that unfortunately your taff. Have they any dome tic worries? When did they exi t in many ho pital . last have leave? re they afraid of the Si ter in tbe ward in The head of the department to which a ick member of the which they are working? re they on day or night duty? staff belong (or a deputy) hould be informed that the staff Have they any pay querie that have Dot been settled? Are member ha reported ick, and of other facts that he officially they reafly suited to the particular work they are performing? need to know. The iter who a i ts the medical officer In hort. are they happy in the service? hould report back to the head of the department at the end CO CLU 10 of the sick parade indicating the name of tho e admitted and tho e put off duty. The diagno is hould not be di clo ed The object of a hospital administrator should be to keep to all and undry. down the taff ickness rate in his institution. In his work to this end comparative figures from other similar bospitals It is desirable that the ervice of con ultants on the staff are u eful. Measured in terms of sick pay alone the annual of the ho pital be a a'ilable; but all requests for consultations co t of taff ickne must be enormous. hould be made through the medical officer who conducts the ick parade. In turn the report should be sent to him in REFERE CES the first in tance. The taff doctor hould be regarded a the I. Mitchell. F. K. (1957): s. Arr. Med. J., 31, 671. 2. Hill. R. C. J. (1955): Ibid., 29. 344. family general practitioner who i always in the picture. 3. Editorial (1955): Ihid.• 29, 331. lllSTORY OF AESTHESIA IN SOUTH AFRICA * H. J. SCHMlDT, M.B., CH.B., M.MED. (A AES.) When the Dutch East lndia Company sent out Johan van Riebeeck only item with analgesic properties mentioned in this list, as to the Cape of Good Hope it was with the intention of e tabli hing would be expected from the date of its publication. a half-way tation for their hips travelling bel\veen Europe and Further information can be derived from the records ofa med.ical the Ea t, so that the crew could be provided with fresh provision society \ hich f10uri hed in Cape Town from 1827 (or earlier) to for the long voyage which lay ahead of them. It took over 3 month 1847. On 2 ovember 1830 the members of this society laid down for the ailing ship to arrive at the Cape from Holland. The the following fees: ship' surgeons had a bu y time in deating with the many ai.lments £ s. d. £ s. d. For imroducing bougie. probang, catheter, extracting amongst the pa nger and the crew, becau e disea e, especially teeth, cupping, bleeding, and minor operations . 0 3 0 to 0 15 0 curvy, \ as extremely prevalent because of the poor diet and For the operations of hare-lip, hydrocele, excision of unhygienic condition on board. tumours, tapping. amputation of toes and fingers .. 0 15 0 to 2 2 0 For reducing fracture and dislocations.. 1 10 0 to 4 0 0 In 1656, 4 year after van Riebeeck established the settlement For capital operations, viz., hernia, amputation, aneur- at the Cape, a ho pital had been built for the treatment and con­ ism. trep3.nniDg, lithotomy, extirpation of mamma, vale cence of patients on the incoming ships. In subsequent cataract, etc. 3 0 0 to 15 0 0 year the accommodation in this hospital wa found to be in­ Other interesting features of medical work at that time are adequate and bigger institutions were erect d by van Riebeeck's obtained from original papers presented at the meetings of this su ce ors. The Company hospitals admitted only their own ociety, the title of ome being: (I) Rupture of bladder; (2) opera­ employees, people who ailed on their hip or members of the tion for spina bifida, successful; (3) abscess of liver opened (1829); military gdrri on. (4) diffused femoral aneurism successfuJly treated by ligature of the In those day th Cape Colony had no medical men \ ith a external iliac artery (J 33); (5) a report of a chemical analysis of univer ity education. The barber surgeon and urgeons, who Cape opium; (6) gangrenou sloughing ulcer, cured by opium, had received their training by being apprenticed to a qualified gradually increased up to 125 minim daiJy of laudanum. 3 man, alone represented the medical profes ion. Their knowledge, This give us a glimpse of the events in those early days, but how however, wa limited. The barber surgeon knew only how to was the pain associated with certain conditions and operations treat wound, and the urgeon employed mainly bleeding and dealt with in the pre-anaesthetic era? purgatives for mo t of the ailment with which they had to deal. Dr. C. P. Thunberg, \ ho visited the Cape between 17 2 and I 75, report : 'Both in the ho pital and on board their hip, the Company PRE- AESTHETIC ERA had, for the great r part, ignorant and un killed surgeon; when a Some knowledge of this period is taken from the writings published kilful surgeon wa found he was a foreigner." by laymen. Peter Kolben in hi book Caput Bonae Spei Hodiemum Some 30 year later in a book published by the Batavian (p. 568) relates that the Hottentots, one of the original tribes Government in I 02, a list of the medicines and urgical equip­ inhabitulg the Cape had their own barber surgeons. They were ment i ued! gives ome idea of the operation that could be acqu~inted with the treatment of wounds and other injuries, with performed. Th li t covers amputations trepanning, herniotomy, cuppmg and with bleeding. When one of their patients had exci ion of fistula-in-ano and e traction of teeth. Opium is the abdominal pain, epiga tric discomfort or chest pain they did not admini ter internal medicines immediately but first resorted to • From the Department of Anaesth ia. niversity of Cape Town. Essay submitted in partial fulfilment of the ,equiremenlS for the degree of M.Med. cupping. A cow or ox horn was cut, leveJled and sucked to the naesthesia) of the University of Cape Town. area of pain until it caused the skin to become anaesthetic. The 1 Maart 1958 S.A. TYD KRIF VIR GE EESKUNDE 245 horn \ a then forcibly removed and the kin in ised with a few om e tent parallel imilar occurren described by Thoma cut about half an inch in length. ub equently the horn wa Key in hi book The Hi foryof urgical Anesthe ia. reapplied 0 er the incised area and kept in thi po ition until it filled with blood and fell off on it own accord. The procedure Ether took 2 or more hours depending on the depth and ize of the ut In the following year the pe Town ne\ papers teemed \ ith made. account from ove ea of the use of ulphuri ether by inhalation When confronted with a woman in difficult labour they admini ­ during operation to produce in n ibility to pain which, it wa tered tobacco or dagga mi ed with mil.k 10 ha ten delivery. This said superseded even the pretention of m meri m. t lhi time probably had its beneficial effect by acting as a narcotic.' public demonstrations of hypno i were being held in ape Town, This type of medication in ob tetries was not only used by the and from India report arrived of Or. James daile' \ ork or Hottentots. Kolben (p. 322) des ribes a case of ob tructed labour, operating on patient \ ho were in a hypnotic tate, a method in which a a last resort Virginian IObacco w hredded into which in later years \ a used \ ith ome uee in outh frica.8 water and the mi ture boiled, trained and cooled. fter the patient One of the ne\ papers" referred to Or. Henry BigeJow' addre , had taken the fluid-e tract by mouth, , he was deli ered of the whi h wa the first exten ive report to be made on ether ana _ child and of the violent pain'.
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